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Clinician-centred interventions to increase vaginal birth after caesarean section (VBAC): a systematic review.
University of Gothenburg.
Trinity College Dublin.
University of Gothenburg.ORCID iD: 0000-0002-3195-5702
University of Eastern Finland.
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2015 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, no 16Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The number of caesarean sections (CS) is increasing globally, and repeat CS after a previous CS is a significant contributor to the overall CS rate. Vaginal birth after caesarean (VBAC) can be seen as a real and viable option for most women with previous CS. To achieve success, however, women need the support of their clinicians (obstetricians and midwives). The aim of this study was to evaluate clinician-centred interventions designed to increase the rate of VBAC.

METHODS: The bibliographic databases of The Cochrane Library, PubMed, PsychINFO and CINAHL were searched for randomised controlled trials, including cluster randomised trials that evaluated the effectiveness of any intervention targeted directly at clinicians aimed at increasing VBAC rates. Included studies were appraised independently by two reviewers. Data were extracted independently by three reviewers. The quality of the included studies was assessed using the quality assessment tool, 'Effective Public Health Practice Project'. The primary outcome measure was VBAC rates.

RESULTS: 238 citations were screened, 255 were excluded by title and abstract. 11 full-text papers were reviewed; eight were excluded, resulting in three included papers. One study evaluated the effectiveness of antepartum x-ray pelvimetry (XRP) in 306 women with one previous CS. One study evaluated the effects of external peer review on CS birth in 45 hospitals, and the third evaluated opinion leader education and audit and feedback in 16 hospitals. The use of external peer review, audit and feedback had no significant effect on VBAC rates. An educational strategy delivered by an opinion leader significantly increased VBAC rates. The use of XRP significantly increased CS rates.

CONCLUSIONS: This systematic review indicates that few studies have evaluated the effects of clinician-centred interventions on VBAC rates, and interventions are of varying types which limited the ability to meta-analyse data. A further limitation is that the included studies were performed during the late 1980s-1990s. An opinion leader educational strategy confers benefit for increasing VBAC rates. This strategy should be further studied in different maternity care settings and with professionals other than physicians only.

Place, publisher, year, edition, pages
2015. Vol. 15, no 16
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hb:diva-13989DOI: 10.1186/s12884-015-0441-3PubMedID: 25652550OAI: oai:DiVA.org:hb-13989DiVA, id: diva2:1199545
Projects
OptiBIRTH
Funder
EU, FP7, Seventh Framework ProgrammeAvailable from: 2018-04-20 Created: 2018-04-20 Last updated: 2018-04-23Bibliographically approved

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